Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Approximately 30,000 Canadians suffer a hip fracture per year, and this number is expected to increase with an aging population. Patients aged 60 years and older with a displaced femoral neck fracture (representing >30% of all hip fractures) are typically treated with one of two prosthetic implants: a total hip replacement or a partial hip replacement. Several trials suggest that total hip replacement is superior to partial hip replacement, since it is associated with less pain and fewer complications; however, there are important differences between patients recruited in these trials and the average patient who has a hip fracture. The latter tends to be older, frailer, and have multiple health conditions that puts him/her at higher risk of complications. Population-level research suggests that patients treated with total hip replacement are having more complications than expected from trial data. Also, there is significant variation in treatment type based on surgeon training and geographic location. This project has two parts. The first set of objectives involves the use of healthcare administrative data to look at the outcomes (death, complications, pain, functional status, and ministry healthcare costs) of all Ontario patients aged 60 years and older treated with each type of prosthetic implant for hip fracture. For the second part, we will explore reasons for the existing variation in care by conducting a census of Orthopaedic Surgeons across Ontario. This research will allow us to understand why there are individual-level and system-level differences in the care of older patients with hip fractures. This is the first step to changing medical practice and improving the care we provide to patients with hip fractures. This work will help clinicians decide which surgical treatment is most effective for patients with displaced femoral neck fractures outside the trial setting.